Montgomery County

Mental /Behavioral Health

L.A. County taking a new approach to help homeless who are severely mentally ill

Daily News - 11/6/2017

Nov. 06--The homeless man was naked when Santiago Reyes found him lying on a Pasadena street.

He had fallen off his wheelchair in the rain as Reyes, an outreach worker who knew the man's mental-health history, called everyone he could for help. 9-1-1. The county. The city. Cop friends.

"The paramedics wouldn't consider him gravely disabled," Reyes said, recalling how difficult it was that day to find help, to connect the man to services.

In Reyes' line of work, such days are common.

A knot of red tape and other challenges has blocked law enforcement, healthcare providers and outreach workers such as Reyes from providing immediate help to homeless people diagnosed with post-traumatic stress disorder, schizophrenia or other mental illnesses. Civil-liberty laws, an inconsistent network within Los Angeles County's courts and health systems and lack of beds in psychiatric units have become roadblocks.

But providers and those who engage in outreach say they are seeing the knot start to loosen. In recent months, a flurry of actions and discussions by LA County leaders has pushed caring for people diagnosed with severe mental illnesses into sharper focus.

Since August, Los Angeles County supervisors have approved:

Providers say this focus grew out of social-justice concerns that could no longer be ignored. At least 30 percent of inmates are diagnosed with mental illnesses at Los Angeles County's Twin Towers Correctional Facility, known as the largest de facto mental institution in the nation.

Also, a report by the Los Angeles Homeless Services Authority found that 17,000 of the county's 58,000 homeless people say they have been diagnosed with a mental illness.

"I think the homelessness issue and the jail issue drove the county, and made it impossible to maintain the status quo," said Brittney Weissman, executive director of the National Alliance on Mental Illness, Los Angeles County Council.

Weissman credits Los Angeles District Attorney Jackie Lacey for her top goal of diverting people with diagnosed mental illnesses out of the jails. Supervisor Mark Ridley-Thomas and Sheila Kuehl also established the Office of Diversion and Reentry in 2015. The program sends low-risk offenders with serious mental illness and substance abuse disorders into treatment, rather than jail, "while preserving public safety." according to the supervisors.

"That emphasis on treatment, recovery and diversion," Weissman said, "that shift has really become part of the county's ethos." She thinks it is likely to continue.

"The leadership is in place and they're all rowing in the same direction," Weissman said.

But there are deeper discussions that still need to take place, too, Weissman and others noted.

Last month, the board approved 12 of 13 recommendations focused on how to improve the network of care delivered by the Department of Mental Health. The board backed away from approving one recommendation that would seek state legislation to expand the criteria for those deemed "gravely disabled."

State law defines "gravely disabled" as "a condition in which a person, as a result of a mental disorder, is unable to provide for his or her basic personal needs for food, clothing, or shelter." Other criteria need to apply before an individual may be taken for a 72-hour involuntary evaluation and treatment at a psychiatric facility.

A week later, the Board voted 4 to 1 to move forward with the effort. Supervisor Kuehl disagreed with the motion, however, maintaining that a county-sponsored bill could start out one way when it is introduced in Sacramento but later be reshaped into a different piece of legislation that could hurt people and thwart local lawmakers' initial intentions.

"You don't want to be stuck with a bad bill," said Kuehl, who once served as chair of the state Senate's Health and Human Services Committee. Kuehl also said she was concerned about how an expanded definition of "gravely disabled" could be interpreted.

Weissman said NAMI is on the side of broadening the definition but commended Kuehl for raising those concerns.

"I think the homelessness issue and the jail issue drove the county, and made it impossible to maintain the status quo."

-- Brittney Weissman, executive director of the National Alliance on Mental Illness, Los Angeles County Council

The discussion is what Dr. Jonathan Sherin, director of the Los Angeles County Department of Mental Health, called a lightning-rod topic because it involves finding balance between defending a person's autonomy and societal paternalism.

Such discussions have to take place, he added.

"We have a lot of disagreement among multiple stakeholders about the definition of grave disability as it exists not only on how that legal definition can be modified," Sherin said. "We are going to explore this arena with great detail and from various viewpoints. We all have to come together and identify our shared interest in providing humane care."

Sherin, appointed to his position late last year, said he is encouraged by the board's actions to help him lead his department to expand the quantity and quality of ongoing outreach efforts. He called the recent actions a once-in-a-generation opportunity. Challenges remain, he acknowledged, such as an enduring stigma in some communities about mental illness.

"With the current climate with this board, the District Attorney's office and law enforcement, we have a rare opportunity to advance this field right now," Sherin said.

"We've noticed it and I'm encouraged (the Board of Supervisors) are looking at (mental health) in a comprehensive way," Gannon said. "Even in law enforcement, we all realize there's got to be a different way we deal with these folks."

Reyes -- a team member with Housing Works, an organization that provides supportive social services --said despite the roadblocks he encounters, more people are getting help. He's happy, he said, to be part of the efforts. On a recent day, he visited with residents at T. Bailey Manor, a 56-unit supportive-housing complex in Eagle Rock for formerly homeless veterans with severe mental illness.

One resident, 57-year-old U.S Army veteran Richard Ross, was found living on the streets six months ago, his hip broken in three places. He suffered from pneumonia and a heart condition-- and had been diagnosed with PTSD.

"I would have called him gravely disabled," Reyes said.

Celina Alvarez, executive director of Housing Works, said places like T. Bailey Manor are the end result of hard work and pushing barriers aside. She too is encouraged by the momentum she sees among county officials, and wants conversations to continue, long after the most vulnerable people are housed.

"It is a change for the good," she added. "It leaves us very hopeful."